Date of Award

Spring 4-28-2016

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Clinical Psychology (PhD)

Department

Clinical Psychology

First Advisor/Committee Member

Amy Mezulis, Ph.D.

Second Advisor/Committee Member

David G. Stewart, Ph.D.

Third Advisor/Committee Member

Dawn M. Ehde, Ph.D.

Abstract

Chronic pain is a common, costly, and debilitating problem. The biopsychosocial model purports that biological, psychological, and social factors are involved in the experience of chronic pain. Multidisciplinary pain management programs adhere to the biopsychosocial model and successfully treat and manage chronic pain. Depression, anxiety, and opiate analgesic medication misuse and abuse are significant problems faced by many individuals with chronic pain, however these relationships are not well understood. This study examined a sample of 248 chronic pain patients who completed a multidisciplinary pain management program. Two hypotheses were tested. First, it was hypothesized that the relationships amongst change in pain, pain-related anxiety, depression, and change in opiate analgesic medication use would be significantly correlated. Second, it was predicted that change in emotional distress would mediate the relationship between change in pain and change in opiate analgesic medication use. Structural equation modeling and residualized change scores were used to examine the hypothesized relationships. Participants ranged from 24 to 81-years-old (M = 44.4, SD = 9.67), 65% of the participants were male, and they were primarily Caucasian (86.0%). The first hypothesis was largely supported, as there were significant correlations among change in pain and change in anxiety (r = .202), change in pain and change in depression (r = .310), change in anxiety and change in depression (r = .587), change in opioid use and change in anxiety (r = .188), and change in opioid use and change in depression (r = .178) . The second hypothesis was also supported, as change in emotional distress indirectly affected the relationship between change in pain and change in opiate analgesic medication use (β = .050; 95% CI = .017 to .099, p = .003). Our findings suggest that emotional distress is a critical variable to address not only when treating chronic pain but also when working with patients with problematic opioid use. These findings have important treatment implications, and suggest that interventions focusing on treating emotional distress may help decrease problems associated with opioid use.

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